中国五城市老年人日常生活能力-失能危险因素分析

Risk factors for activity of daily living-disability in the elderly living in 5 cities of China

目的分析老年人日常生活能力(ADL)-失能的相关影响因素。方法对上海、北京、广州、成都、重庆五城市养老院、社区卫生服务中心及综合医院3类机构中年龄≥65岁老年人进行调查。采用病例-对照研究,对调查对象进行面对面问卷调查和体格检查,内容包括ADL、健康和营养等方面。判断失能与营养评价分别采用ADL-Barthel指数评定量表和微型营养评定法简版(MNA-SF)。采用SPSS 16.0软件进行统计分析,组间比较采用x^2检验。多因素logistic回归分析老年人ADL-失能的影响因素。结果最终4929人入选本研究,根据失能情况分为病例组(<20分,n=379)与对照组(≥60分,n=4550)。两组年龄、城市、机构、所患疾病(心脑血管系统疾病、消化系统疾病、呼吸系统疾病、泌尿系统疾病、骨骼系统疾病)差异均有统计学意义(P<0.05)。两组意识、呼吸、体温、水肿、黏膜、皮肤弹性、咀嚼能力及牙齿差异均有统计学意义(P<0.05)。所有入组者中,营养状况正常占50.9%(2509/4929),存在营养风险33.66%(1659/4929),营养不良15.44%(761/4929),两组营养状况差异具有统计学意义(P<0.001);多因素logistic分析显示,精神神经系统疾病(OR=3.41)、咀嚼功能较差(OR=2.03)、心血管系统疾病(OR=1.87)、>90岁(OR=1.84)、泌尿系统疾病(OR=1.55)是老年人AD-失能的危险因素;良好的营养状况(OR=0.73)和消化系统疾病(OR=0.51)是老年人AD-失能的保护因素。结论 >90岁、咀嚼功能差、营养不良、患有精神神经、心血管及泌尿等系统疾病的老年人ADL-失能的风险增大。

Objective To investigate the influencing factors for activity of daily living（ADL）-disability in the elderly.Methods A case-control study was performed on the elderly subjects（over 65 years old）who came from nursing homes, community health centers and general hospitals in Beijing, Shanghai, Guangzhou, Chengdu, and Chongqing.Face-to-face questionnaires and physical examinations were conducted on the participants to survey their DLA, health and nutritional statuses.ADL-Barthel index and mini-nutritional assessment short form（MNA-SF）were used for assessment of disability and nutritional status.SPSS statistics 16.0 was used to perform the statistical analysis.Chi-square test was employed for intragroup comparison, and multivariate logistic regression analysis was adopted for the influencing factors for ADL-disability.Results A total of 4929 subjects were finally enrolled in this study,and according to disability condition,they were assigned into case group（〈20 points,n=379）and control group（≥60 points,n=4450）.Significant discrepancies were found in age, city, institution, and comorbidities（cardiovascular and cerebrovascular diseases,digestive diseases,respiratory diseases,urinary diseases,and skeletal diseases）between the 2 groups（P〈0.05）.There were obvious differences in consciousness,breath,temperature,edema,mocous membrane,skin elasticity,chewing ability and tooth （P〈0.05）.Among the all participants,50.90%（2509/4929）were at adequate nutritional status,33.66%（1659/4929）at risk of malnutrition,and 15.44%（761/4929）in malnutrition.Notable differences were also seen in the nutritional status between the 2 groups（P〈0.001）.Multivariate logistic regression analysis showed that mental and nervous diseases（OR=3.41）,poor masticatory function（OR=2.03）,cardiovascular diseases（OR=1.87）,over 90 years old（OR=1.84）and urinary diseases（OR=1.55）were risk factors for ADL-disability,while adequate nutritional status（OR=0.73）and digestive diseases（OR=0.51）were the protective factors.Conclusion The elderly over 90 years old,with poor masticatory function,and suffering from mental and nervous diseases, cardiovascular diseases and urinary diseases are prone to ADL-disability.